My Experience & observations with Microfoam Sclerotherapy (MFST)
As on this date, I have done more than 25,100 MFST. I did the first Sclerotherapy in 1995, with plain Polidocanol diluted with Normal Saline. It was only from 2007, I switched over to Microfoam Sclerotherapy (MFST). While I did this on 8 patients in 1997, now we do more than 3500 cases every year. The progressive curve from 1997 to March 2016 will explain the successful outcome of the procedure as well as the patient acceptance. From 2009, it is a Research Institute in collaboration with The Rajiv Gandhi Centre for Biotechnology, Thiruvanamthapuram, Kerala, India. This association has helped us to find newer dimensions in the field of the etio-pathogenesis of the Varicose Veins and to evolve a modification in the  technique of MFST . My technique is different form the usually described Microfoam Sclerotherapy and is called Modified Microfoam Sclerotherapy (MMFST) or a Chemical Bombing*. This technique is routinely followed here and this is the one which brings out excellent results.

My observations are summarised below:
Out of more than 25000 patients who underwent this minimally invasive procedure, more than 21,200 patients underwent the Modified Microfoam Sclerotherapy (MMFST).

1.(a) Chronic manifestations (CVD): 

15% of the patients  belong to Class VI (CEAP) Group (with non healing extensive Ulceration of foot). About (10 % ) present with Class V (recurrent or healed ulceration); 40% with Class IV (Eczema, extensive hyperpigmentation, itching, Lipodermatosclerosis and atrophic blanche); (15%) with Class III  (Lower limb edema),( 20%) with Class II & I (Classical Varicose Veins & Spider/ reticular veins).

1.(b) Acute manifestations:
1. Bleeding (4%)
2. Thrombophlebitis (1%)
3. Cellulitis(3%)
4. Secondary VV (DVT) 1%

2.   No allergic/ or hypersensitivity reactions detected .
3.   Pseudo reactions are very common and misguiding.
4.  Very small blister formation may occur around the ankle or the foot when the sclerosant is administered to very tiny veins where large areas of venous aggregations are present.
5.  The incidence of DVT is extremely rare and four cases have been reported so far out of 16000 patients  of which 2 cases are pulmonary embolisms due to pelvic vein thrombosis as a result of prolonged recumbancy and immobility and 2 cases of DVT due to thrombosis in the calf veins.
6.  About 5% of the patients have experienced dryness of mouth and mild heaviness of head after the procedure.
7.  2% of patients have cough during the procedure.
8.  Dark staining along the length of vein is observed in the healing phase.
9. Very young patients usually develop hypotension due to apprehension but the procedure can be continued immediately after the recovery.This is the main reason that the procedure should be done in an operating room with monitoring facility. It should never be done as an Out Patient procedure.
10. Recurrence after the procedure is due to recanalisation, revascularisation and large extent of veins.Local Hirsuitism (hypertrichosis) is not uncommon.
11.  Microfoam Sclerotherapy is excellent; especially in the sense that the quantity of the drug can be remarkably reduced and the side effects  are practically negligible.
12. Modified MFST is exceptionally good and is a more physiological way of treatment when compared to any other techniques. I hope this would be the promising technique of tomorrow.
13. It has  excellent safety profile.
14. In the larger veins it is not painful. But in very small sized veins, it may produce some pain, but tolerable. Pain is subjective!
15. Rarely. there can have blood clots inside the larger veins and may produce discomfort. In such cases, it is better to evacuate the clots with a stab incision. Tarry blood may come out if it bursts spontaneously.

Follow-up
The most important aspect of successful treatment for varicose vein, is regular follow up after the procedure. This will control recanlisation and neovascularisation and skipped veins . About 5-6 years of follow up with  increasing interval can definitely effect complete control over the disease.

Our Aim of treatment of Varicose Vein(VV)
The aim of treatment of VV is not merely to achieve some cosmetic improvement as is generally thought or considered to be, or just to prevent bleeding from rupture of veins. It is intended to prevent CVD or to get reversed from established final stage of CVD. Chronic Venous Disease (CVD) is a progressive disease right from birth, and it takes a very long time to get itself manifested. It remains hidden for 15 to 25 years. (average 20 years) until we are fully grown. It passes through 7 stages from Class-0 to Class-VI) with the ultimate development of nonhealing, painful, eroding and unsightly ulcerations over the lower leg and ankle. In addition, it will also produce psychological upsets and even tendency to commit suicide.